Provider Demographics
NPI:1316208192
Name:DAVINGMAN, STEPHANIE L (CADC, LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:DAVINGMAN
Suffix:
Gender:F
Credentials:CADC, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 W. HAMILTON RD.
Mailing Address - Street 2:LUTHERAN CHILD AND FAMILY SERVICES
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8657
Mailing Address - Country:US
Mailing Address - Phone:309-834-3231
Mailing Address - Fax:
Practice Address - Street 1:1102 W HAMILTON RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8657
Practice Address - Country:US
Practice Address - Phone:309-834-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-00074701041C0700X
IL166-000510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist